The overall objective of this home-based nurse clinical trial is to utilize pediatric nurse specialists (PNS) to monitor the infant's health status and increase maternal/caregiver effectiveness to enhance health, growth and developmental outcomes in drug-exposed infants.
The specific aims of the 18 month home-based PNS intervention are to (1) reduce infant morbidity defined as feeding problems, impaired growth and development, (2) increase appropriate health care utilization and (3) reduce the rate of child abuse referral and foster care placement in these infants over a 24 month follow-up period. Infants are evaluated for growth, neurodevelopmental and health outcomes at ages 3,6,9,12,18 and 24 months in the Outpatient General Clinical Research Center at Johns Hopkins Hospital. The PNS intervention consisted of the mother- infant dyad receiving a total of 16 home visits during which the infant receive a physical exam for symptoms of neonatal drug withdrawal and common infant conditions. Information regarding infant stimulation was provided to the mother/caregiver. Currently, 206 infants with documented intrauterine drug exposure are enrolled in the longitudinal study. Recruitment ended 1/31/97. Despite numerous techniques to enhance retention, the retention rate for the first 110 infants is 59-62 %. Preliminary outcome data indicate that 37% of 12 month old infants were categorized as """"""""suspect or at risk"""""""" for visual attention and by 18 months 33% of infants were classified with fine motor difficulties, both subtle precursors to attentional deficits, language delays and learning disabilities in preschool children.
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